Case History: A 78-year-old patient with history of weakness on right side.
Case History: A 78-year-old patient with history of weakness on right side.
[[{"type":"media","view_mode":"media_crop","fid":"17821","attributes":{"alt":"","class":"media-image","id":"media_crop_6887480163565","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"1130","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","title":" ","typeof":"foaf:Image"}}]]
Images 1-4: Increased diameter of basilar artery and tortuous coarse.
[[{"type":"media","view_mode":"media_crop","fid":"17825","attributes":{"alt":"","class":"media-image","id":"media_crop_3287200829653","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"1134","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","title":" ","typeof":"foaf:Image"}}]]
Image 2
[[{"type":"media","view_mode":"media_crop","fid":"17826","attributes":{"alt":"","class":"media-image","id":"media_crop_597423559438","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"1135","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","title":" ","typeof":"foaf:Image"}}]]
Image 3
[[{"type":"media","view_mode":"media_crop","fid":"17827","attributes":{"alt":"","class":"media-image","id":"media_crop_9662262833763","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"1136","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","title":" ","typeof":"foaf:Image"}}]]
Image 4
[[{"type":"media","view_mode":"media_crop","fid":"17822","attributes":{"alt":"","class":"media-image","id":"media_crop_8421425504923","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"1131","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","title":" ","typeof":"foaf:Image"}}]]
Image 5: Calcification of MCA right side.
[[{"type":"media","view_mode":"media_crop","fid":"17823","attributes":{"alt":"","class":"media-image","id":"media_crop_8375354237308","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"1132","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","title":" ","typeof":"foaf:Image"}}]]
Images 6: Third and lateral ventricles.
[[{"type":"media","view_mode":"media_crop","fid":"17824","attributes":{"alt":"","class":"media-image","id":"media_crop_2567224788576","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"1133","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","title":" ","typeof":"foaf:Image"}}]]
Image 7
CT showed increased diameter of basilar artery and tortuous course. Calcification seen in ICA, MCA arteries b/l and basilar tip.
Diagnosis: Basilar artery ectasia
Discussion: The term dolichoectasia means elongation and distension. It is used to characterize arteries throughout the human body which have shown significant deterioration of their tunica intima (and occasionally the tunica media), weakening the vessel walls and causing the artery to elongate and distend.
Most commonly caused by hypertension, continued stress on the walls of the artery will degrade the vessel wall by damaging and loosening the collagen and elastin meshwork which comprises the intima. Similarly, hypercholesterolemia or hyperlipidemia can also provide sufficient trauma to the vessel wall resulting in dolichoectasia. As the arrangement of connective tissue is disturbed, the vessel wall is no longer able to hold its original conformation and begins to unravel due to the continued hypertension. High blood pressure mold and force the artery to now take on an elongated, tortuous course to better withstand the higher pressures.
Most commonly affected is the Vertebral Basilar Artery (Vertebral Basilar Dolichoectasia or Vertebrobasillar Dolichoectasia). The Internal Carotid Artery is also at high risk to be affected. Patients with Autosomal Dominant Polycystic Kidney Disease (ADPKD) are more likely to be subject to dolichoectasias. Dolichoectasias are most common in elderly females. In cases involving the Basilar Artery (VBD), the pathogenesis arises from direct compression of different cranial nerves.
Additionally, ischemic effects on the brain stem and cerebellar hemispheres as well as symptoms related to hydrocephalus are common. Direct cranial nerve compression can lead to isolated cranial nerve dysfunction, usually associated with a normal-sized basilar artery that is tortuous and elongated. Cranial nerve dysfunction most commonly involves the VII cranial nerve and the V cranial nerve. Multiple cranial nerve dysfunction is far more likely to occur if there is dilation (ectasia) associated with a tortuous and elongated basilar artery. Cranial nerves affected in descending order of frequency include: VII, V, III, VIII, and VI.
Internal Carotid Artery dolichoectasia is particularly interesting because the artery normally already contains one hairpin turn. Seen in an MRI as two individual arteries at this hairpin, a carotid artery dolichoectasia can progress so far as to produce a second hairpin turn and appear as three individual arteries on an MRI. In the case of a dolichoectasia of the Internal Carotid Artery (ICD), the pathogenesis is primarily related to compression of the Optic Nerves at the Optic Chiasma
Harpreet Singh, MD
JP Scan private diagnostic center, Khanna, Punjab, India
Emerging AI Algorithm Shows Promise for Abbreviated Breast MRI in Multicenter Study
April 25th 2025An artificial intelligence algorithm for dynamic contrast-enhanced breast MRI offered a 93.9 percent AUC for breast cancer detection, and a 92.3 percent sensitivity in BI-RADS 3 cases, according to new research presented at the Society for Breast Imaging (SBI) conference.
The Reading Room Podcast: Current Perspectives on the Updated Appropriate Use Criteria for Brain PET
March 18th 2025In a new podcast, Satoshi Minoshima, M.D., Ph.D., and James Williams, Ph.D., share their insights on the recently updated appropriate use criteria for amyloid PET and tau PET in patients with mild cognitive impairment.
Can Abbreviated Breast MRI Have an Impact in Assessing Post-Neoadjuvant Chemotherapy Response?
April 24th 2025New research presented at the Society for Breast Imaging (SBI) conference suggests that abbreviated MRI is comparable to full MRI in assessing pathologic complete response to neoadjuvant chemotherapy for breast cancer.
Clarius Mobile Health Unveils Anterior Knee Feature for Handheld Ultrasound
April 23rd 2025The T-Mode Anterior Knee feature reportedly offers a combination of automated segmentation and real-time conversion of grayscale ultrasound images into color-coded visuals that bolster understanding for novice ultrasound users.